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President's Message

august 2023

Dear MDACC Members:

If you have an interest in health policy (loosely defined as the decisions, actions, and plans that govern the delivery of care) we have a position for you! The ACC Carrier Advisory Committee (CAC), a workgroup of the Board of Governors, plays an essential role in monitoring and influencing the state and regional activities of the Medicare Administrative Contractors (MAC). Each ACC state chapter appoints a CAC representative to ensure local coverage determinations reflect existing ACC/AHA guidelines and current clinical practice in order to deliver appropriate, high-quality cardiovascular care to patients. We are in search of a CAC representative that would sit on the Maryland Chapter Council and be a part of the 50-state workgroup at the national level.

Time commitment generally includes:

    • State Chapter Council meetings: The extent of participation varies according to each chapter. The CAC representative should work with the state governor to establish regular communication to the council.
    • CAC meetings [administered by the MACs]: one to two hours per meeting with as many as one meeting per quarter - have been virtual since 2020.
    • ACC CAC meeting: one hour at ACC Annual Scientific Session. 
    • Engaging with emails related to providing comments on draft LCDs.

If you are interested, please email Executive Director Jennifer Ray Beckman (


Sammy Zakaria, MD, FACC

Governor-elect, Maryland Chapter ACC



Bills in both the Maryland House of Delegates and Senate have been introduced to reform prior authorization and step-therapy.  MDACC is supporting these reforms through letters, in-person testimony, and an email campaign to the membership.  See below for more details.

RE: SUPPORT FOR SB 308 Health Insurance – Utilization Review – Revisions and

SB 515 Health Insurance – Step Therapy or Fail First Protocol – Revisions

These bills target the unnecessary denial of health care services by health insurers. Commonly known as prior authorization or step therapy, these practices often delay or deny medications and services that have received clinical consensus through stringent vetting and are published and updated regularly in medical journals and literature.

Time is critical for cardiovascular patients. The sooner a cardiologist can treat and monitor a

patient, the more likely the patient is to recover and thrive. Unfortunately, insurer prior authorization program denials in Maryland are rising.

Increasingly, cardiovascular professionals use point of care tools (ACC Practice Tools) and other technological resources (NCDR National Cardiovascular Data Registry) to access information that provides update information that guides treatment decisions and helps them provide timely care.

  • In 2018, there were 78,314 denials based on medical necessity.
  • In 2021 that number increased to 81,143.
  • The Maryland Insurance Administration (MIA) ruled that in over 70% of complaints they received from patients, the denial was invalid, and that the patient should have received the health care service.

In 2021, an American Medical Association (AMA) survey revealed the following about the impact of prior authorization on physicians and patients:

  • 93% of physicians reported delays in access to necessary care.
  • 82% of physicians reported that patients abandoned recommended treatments because of prior-authorization denials.
  • 73% of physicians reported that criteria used by carriers for determining medical necessity is questionable - 30% of physicians reported that it is rarely or never evidence-based and 43% only sometimes evidence-based.
  • 88% of physicians describe the burden of prior authorizations as high or very high with 40% of physicians reporting that they have staff dedicated exclusively to prior authorizations.

Not only are these policies hurting patients, but they are hurting physicians, too.

The process to secure prior authorization is labor intensive, costly, and stressful. Surveys consistently reveal that undue administrative burden is a leading cause of physician burnout and depression.

The Maryland Chapter ACC supports the American College of Cardiology’s statement of support for the Ukrainian people; see this link for the full statement.

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The Maryland Chapter was featured in the May 5th Board of Governors Update, a weekly newsletter to all Chapter Presidents.  Click here to read!

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Maryland Chapter, American College of Cardiology
1783 Forest Drive, Suite 238
Annapolis, MD 21401

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